What is the Cross-Reactivity Frequency in Patients with Penicillin Allergy who Receive Cefazolin?
BACKGROUND AND PURPOSE:
Sousa-Pinto et al. (JAMA Surg, 2021) examined the incidence of cefazolin allergy in patients with allergy to natural penicillins
Systematic review and meta-analysis
Research databases through July 31, 2020
Study inclusion criteria
A natural penicillin (penicillin, amoxicillin, or ampicillin) where patients were tested for tolerability to cefazolin
Cefazolin where patients were tested for tolerability to a natural penicillin
Data independently extracted by 2 authors following removal of duplicate studies
Bayesian random-effectsmeta-analysis with 95% credibility intervals (CrI) was used to estimate the frequency of allergic reactions
Dual allergy to cefazolin and a natural penicillin
77 studies | 6147 patients
Dual Allergy Frequencies
Cefazolin allergy identified in patients with a penicillin allergy
Frequency of 0.7% (95% CrI, 0.1% to 1.7%)
Penicillin allergy identified in patients with a cefazolin allergy
Frequency of 3.7% (95% CrI 0.03% to 13.3%)
The frequency of dual allergies was lower for participants with unconfirmed penicillin allergy
Unconfirmed: Frequency of 0.6% (95% CrI, 0.1% to 1.3%)
Confirmed: Frequency of 3.0% (95% CrI, 0.01% to 17.0%)
Surgical Patients Only
13 studies | 3884 patients
Cefazolin allergy in surgical patients with a penicillin allergy
Frequency of 0.7% (95% CrI, 0% to 3.3%)
Penicillin allergy in surgical patients with a cefazolin allergy
Frequency of 4.4% (95% CrI, 0% to 23.0%)
Most patients with a history of penicillin allergy may safely receive cefazolin with only 0.7% of patients exhibiting cross-reactivity
Extra caution suggested for patients with confirmed penicillin allergy
Results were similar for patients in a surgical setting
The authors conclude
…cross-reactivity between penicillins and cefazolin was rare, with hypersensitivity reactions to cefazolin occurring in less than 1% of patients with unconfirmed penicillin allergy and in 3% of patients with allergy confirmation
The low frequency of penicillin-cefazolin dual allergy suggests that most patients should receive cefazolin regardless of penicillin allergy history
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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